SYSTEMATIC REVIEW article
Front. Cardiovasc. Med.
Sec. Lipids in Cardiovascular Disease
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1612095
This article is part of the Research TopicHDL and Cardiovascular Disease: Mechanisms, Clinical Relevance, and Therapeutic ImpactsView all 5 articles
Effectiveness of Combining PCSK9 Inhibitors with Statins on Major Adverse Cardiovascular Events and Lipid Levels in Patients after Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis
Provisionally accepted
- 1Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, China
- 2Department of Cardiology, Affiliated Xiamen Hospital of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Xiamen, China
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Background Few percutaneous coronary intervention (PCI) patients achieve low-density lipoprotein cholesterol (LDL-C) targets with statins alone. While proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors effectively diminish LDL-C levels, their combined use with statins for reducing major adverse cardiovascular events (MACE) and improving lipid profiles post-PCI requires further validation. This study seeks to appraise the therapeutic impact of PCSK9 inhibitors combined with statins on MACE and blood lipids in patients following PCI. Methods Randomized controlled trials (RCTs) and cohort studies as of February 2025 in the PubMed, Embase, Cochrane Library, and Web of Science databases were identified. Regarding the risk of bias evaluation, Cochrane ROB 2.0 was employed for RCTs. Moreover, cohort studies were appraised by means of the Newcastle-Ottawa Scale. In terms of heterogeneity, it was appraised by means of the I2 statistics. The relative risk (RR) and 95% confidence interval (CI) for dichotomous variables, along with the weighted mean difference (WMD), standardized mean difference (SMD), and their respective 95% CIs for continuous variables. Results The meta-analysis included 17 studies, including 9 RCTs and 8 cohort studies, involving 5,607 subjects. The meta-analysis revealed that, against the statin group, the combination therapy group displayed a notable decline in MACE incidence (RR: 0.61; 95% CI: 0.50 to 0.75; p < 0.001; I2 = 0.0%). Meanwhile, the combination therapy group demonstrated greater LDL-C reduction versus statin monotherapy (SMD: -1.29; 95% CI: -1.70 to -0.87).Moreover, The combination therapy group achieved significantly higher LDL-C ≤1.4 mmol/L attainment rates versus statin monotherapy (RR: 5.83; 95% CI: 5.20 to 6.55). Conclusion: PCSK9 inhibitors combined with statins significantly reduces MACE incidence, improves lipid profiles in post-PCI patients compared to statin monotherapy. Systematic Review Registration: https://www.crd.york.ac.uk/, identifier (CRD420250650716).
Keywords: PCSK9 inhibitors, Statin (HMG-CoA reductase inhibitor), Post PCI, Major adverse cardiovascular events (MACE), LDL-cholesterol, Lipid, meta -analysis
Received: 28 Apr 2025; Accepted: 13 Oct 2025.
Copyright: © 2025 Cao, Chen, Chen, Xu, Zhang and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yunsu Wang, 2585736024@qq.com
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